The PPT presents in brief the importance and effect of age on cardio-pulmonary system

1. Effect of aging in
CARDIO-PULMONARY SYSTEM
Krishna priya

2. ?
PHYSIOTHERAPY - AGING

3.  Physiological changes
 Exercise prescription
 Exercise response
 Factors affecting aging – biological and psychological
factors, disuse, disease etc…….
SAFETY OF THE CLIENT DURING REHABILITATION

4. ANATOMICAL -
 Increase in heart weight
 Decrease in myocardial cells and enlargement of
remaining cells
Cardio-vascular system

5.  Increased left ventricular thickness
 Increase in left atrial size
 Reduced elastin and increased collagen in the intimal
layer of the heart and blood vessel walls and
calcification stiffness
 Decreased aortic distensibility

6.  Stiffness increase in systolic blood pressure
 Decreased distensibility increased load on LV
AT REST
Diastolic properties
EDV in cardiac cycle -
 Sufficient venous return
 Relaxation of ventricles
 Duration of atrial contraction
 Inspite of the stiffness if the walls, LA increase in size
maintains EDV
Relation between anatomical and
physiological changes

7.  Increase in iso-volumic myocardial relaxation
 Decrease in ventricular filling rate in early diastole
 Over all increased diastole of ventricles
DURING ACTIVITY OR MINIMAL EXERCISE
 EDV index increases
 Ventricular filling rate decreases due to prolonged
relaxation time and ventricular stiffness

8. AT REST
Systolic properties
 End systolic volume
 Stroke volume same
 Ejection fraction
DURING ACTIVITY OR MINIMAL EXERCISE
 End systolic volume
 Ejection fraction
 Myo-cardial contractility

9. Causes –
 Decreased response to B-adrenergics
 Systolic BP
 Ventricular wall changes
AEROBIC CAPACITY
 VO2 max
 As age VO2 max
 0.4-0.5 ml/kg/min/yr – male
 0.2-0.35 ml/kg/min/yr – female
 10% per decade

10.  VO2 max inversely proportional to body weight and
physical inactivity
Causes –
 Maximum HR
 CO and SV
 A-V O2 difference
OTHER CHANGES
 Reduced baro receptor and cardio pulmonary reflexes
 Reduced A-V dilatation
 Postural hypotension

11. Diastole –
 Left ventricular wall thickness
 Left ventricular filling rate
 End diastolic volume
Systole –
 Myocardial contractility
 End diastolic volume
 Ejection fraction
Effect of aging

12.  Arterial wall thickness
 Systolic blood pressure
 Diastolic blood pressure
 Orthostatic tolerance
 Arterial and venous dilation
 Vasoconstriction
same

13.  Cause peripheral effects not central
 HR max cannot be changed so SV, CO, VO2 max cannot
be altered significantly
 Extraction of O2 by peripheral skeletal musculature
 A-V O2 difference
VO2 max increases
 EDV at rest and exercise
 Peak rate of ventricular filling
Effect of exercise training on CVS

14.  6 months – avg- 30 min, 3 times/week, 4-6 months –
increased VO2 max by 14%
 Active / sedentary – VO2 max reduces
(5%) (10%)
Poor improvements in
 Less initial VO2 max
 Increased age
 Short sessions of exercises
 Short over all duration of the study period

15. Study –
60-82 yrs, intensive endurance training,
Increase in EDV and peak ventricular filling rates
Causes
 Increased uptake of Ca
 Reduced relaxation time
 Increased fatty acid oxidation and cytochrome C
oxidase levels

16. Systolic performance
 Increased exercise stroke volume,
 Increased ejection fraction, on exercise
 End systolic volume decrease
Very old age, estrogen deficient women – no changes
on exercise training

17.  Improvement in postural hypotension – blood flow to
peripherally active muscles from inactive limbs and
viscera
 Reduce systolic and diastolic BP
 Reduce age related baro-reflex sensitivity
 Alters ANS and its control on resting HR
 Increase para-sympathetic activity and attenuates
sympathetic activity

18. Long term aerobic training -
 Decrease symp + at given work rate
 Decrease exe HR
 Decrease BP

19. Diastole – on exercise
 Left ventricular wall thickness
 Left ventricular filling rate
 End diastolic volume
Systole –
 Myocardial contractility
 End diastolic volume
 Ejection fraction
Effect of exercise training

20.  Arterial wall thickness ?
 Systolic blood pressure
 Diastolic blood pressure /
 Orthostatic tolerance ?
 Arterial and venous dilation ?
 Vasoconstriction
 Central venous pressure ?

21. PULMONARY SYSTEM

22. Anatomical changes – (thoracic cage, lungs, diaphragm)
decreased –
 Calcification of costal cartilage with sternum
 Degenerative changes in thoracic spine and rib
articulations
 Kyphosis
 Reduced intervertebral spaces, Wedge shaped
 Increases AP diameter
 Resp muscles in mechanically disadvantageous position
 Decreased force generation

23.  Loss of elastic fibres in alveolar ducts
 Loss and destruction of supporting structures of lung
parenchyma
 Pre-mature closure of airways
Hyper-inflation
 Elastic recoil
 chest wall compliance
 Progressive decrease in respiratory muscle strength
(mild)

24.  Compliance – lung and chest wall
 Decrease in chest wall complian
-ce is more than lung compliance

25. Decrease in
 Alveolar – capillary surface area
 Alveolar surface area
 Total surface area of lung parenchyma
 Pulmonary blood flow volume
 Reduced diffusion
 Increased dead space ventilation
 V/Q mis-match

27.  Reduced elastic recoil – reduced exp flow + narrowing
of airways
Reduced FEV1
 Reduced closing volumes, increased FRC and RV
Reduced FVC and flow rates
 Increased FRC TV decreases

29.  Minute ventilation –RR*vol of air inhaled in 1 breath
 Increase in RR, inspite of TV inspiration
 Diaphragm – change in muscle type – reduced type 1
muscle fibres
Easy fatigue during increased load on RS
Increased WOB

30. Immunological changes –
 BAL – broncho alveolar lavage
 Increased neutrophils; IgA, IgM,
 Reduced macrophages
 Antigens toxin production
Increased T lymphocytes
Increased neutrophils
Release of super-oxide

31. Persistent low grade inflammation
Damage to lung matrix
Impaired gaseous exchange
 ELF- epithelial lining fluid – rich in anti-oxidants
Aging – reduced ELF
Increased susceptibility to env toxins

32. 25-35/40 yrs (plateau)
Growth and maturation declines
0-20 yrs
Pulmonary changes also depend on -
nutrition / diet
life style – sedentary/active, smoking
infections, environment
immune system

33.  Chest wall stiffness
 Elastic recoil
 Alveolar capillary surface area
 Forced expiratory flow
 Total residual volume
 Forced vital capacity
 P I max and P E max
 V/Q matching
 Pa O2
 Oxygen saturation
 Pulmonary vascular resistance
Effect of aging

34.  Expiratory flow limitation
 Minute ventilation
 Work of breathing
 Resp muscle O2 consumption
 Pulmonary artery pressure

35. DURING ACTIVITY OR MINIMAL EXERCISE
 Expiratory flow limitation due to narrow air ways
 Increase in minute volume, minimal increase in TV,
more in RR, shortness of breath
 Increased WOB to meet O2 demands via alveolar
ventilation, diffusion
 Exe – stiff alveolar walls – reduced elastic recoil-
increase pressure development by insp and exp
muscles – increased WOB – increased O2 consumption
by resp muscles (10-12% of total body O2 consumption)

36. Sub-maximal exe – aerobic training – MV
 Walking, 70 yr, 12 week sub-maximal aerobic exe, 7.7%
in MV
 Reduced breathlessness
 Low exertion
 Use of low % of max ventilatory capacity during
exercise (reduced WOB)
Effect of exercise training

37. Maximal exercise – 5 days/ week, 78% HR max
 Same case 14% in max MV
 Improved MV in terms of TV not RR

38. aging on exercise
 Expiratory flow limitation
 Minute ventilation S M
 Work of breathing
 Resp muscle O2 consumption
 Arterial hypoxemia
 Pulmonary artery pressure
 Pulmonary wedge pressure
Effect of exercise training

39. Thank You